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Cardiac Troponin-T
Troponin T levels in heart blood as a
marker to diagnose postmortem myocardial
infarction
B. Bheeshma1*, V. Geetha2, Jay Raju3, Sandhya Manohar4
1
Abstract
Cardiac deaths account for 50% of all deaths in developed and 25% in the developing world. OneOne
sixth of worlds population lives in India and heart disease accounts for 24% of all deaths. Sudden
death accounts for two-thirds
thirds of all autopsies in Forensic Medicine.
Medicine. Actual detection of histological
sequence of the infected myocardium will develop only after significant time of, between onsets of
myocardial infarction (MI) in death. Cardiac Troponin-TT is not normally present in serum unless
cardiac necrosis has occurred therefore cardiac Troponin levels
evels act as a specific and sensitive
indication of myocardial infarction. The present study was conducted on cases coming for medico
legal autopsy to the Forensic Medicine Department at Gandhi Medical College/Hospital,
College/Hospital Hyderabad,
Andhra Pradesh, India for a period of 1 year from January 2014 to December 2014. Total 12 cases
with 6 controls were analyzed. Cardiac Troponin-T
Troponin T Level was markedly elevated >2.000 ng/ml in all
except one case of suspected MI. Sensitivity was found
found to be 91.66% and specificity 66.66%.
Key words
Heart disease, Cardiac Troponin--T, Myocardial infarction.
Introduction
st
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Page 109
a
biotinylated monoclonal anti-cardiac
anti
Troponin
T-specific
specific
antibody,
monoclonal anti-cardiac
cardiac Troponin TT
specific labeled with a ruthenium
complex and streptavidin-coated
streptavidin
micro
particles reacted to form a sandwich
complex, which wass bound to the solid
phase. The reaction mixture was seen in
strip method. Cardiac Troponin T levels
were above 2.000 ng/ml.
ng/
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Results
The study and control sample contained 11 and
5 men respectively and one woman in each
group. The average age of the control sample
was 50 (48-56) years and the average age of the
cardiac death sample was 52 (44-60)
(44
years. In
the control sample, two patients died due to
acute organophosphorus
phosphorus poisoning. Three cases
died due to cerebro-vascular
vascular accident and or
metabolic encephalopathy, and one was due to
pulmonary tuberculosis. Cardiac Troponin T
level was markedly elevated (>2.000 ng/ml)
ng/
in all
except one case of suspected MI in the study
sample and also markedly elevated in the
t
control sample except two cases (probably due
to autolysis).
Histopathological examination (HPE) of the
hematoxylin and eosin stained, heart slices,
showed that four cases of the study group had
evidence of early myocardial infarction with
features off myonecrosis, waviness of fibers,
nucleomegaly,
pyknotic
nuclei
and
polymorphous infiltration. Three cases of acute
Sensitivity =
Specificity =
Discussion
World Health Organization (WHO)
(
defines
sudden death as those that occurs within 24
hours of onset of terminal illness. 80% of sudden
cardiac deaths are due to coronary
atherosclerosis. Establishment of cause of death
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in
Conclusion
Forensic pathologistss seldom request Troponin
assay// test in the investigation of sudden cardiac
death because of firm diagnosis
iagnosis of cardiac death
as evident on gross autopsy and histological
findings coupled with significant symptoms.
However not all cardiac
diac deaths show these
finding e.g. Micro infarcts of the myocardium
may produce cardiac arrhythmias and
subsequent death. The search of a reliable
marker to support diagnosis of cardiac injury
was made by this study.
We also should be aware of the laboratorys
normal range, the elevated levels seen in
postmortem control samples, and the anatomic
site from which the sample is drawn. Although,
blood from central locations as the cardiac
ventricles and pericardial fluid
flu showed markedly
increased levels, they best equate anti-mortem
physiologic levels. Moreover, it is necessary to
correlate the laboratory reports with the place
of occurrence, history of the case, and HPE
findings. One issue with this study and studies
up to date is that cardiac
ardiac Troponin T levels are
tested in obvious patients with acute MI and
compared with patients who died of non cardiac
causes. Inevitably, all of these studies
st
concluded
that increased cardiac
ardiac Troponin T levels
correlate with the cause of death and supported
the gross and HPE findings.
ndings. Therefore more
large scale studies are needed before definite
conclusions can be drawn from these assays. It is
hoped that this study can be a foundation for
future larger studies.
The sensitive markers should be that highest
abundance in the cell. The major function of the
heart is contraction, the proteins involved in
contraction in producing the energy are
important biomarkers of cardiac injury which
could be detected in blood and cardio specific
proteins
ins like Cardiac Troponin T levels are more
sensitive and specific biomarkers.
Page 114
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11.
12.
13.
14.
15.
16.
17.
18.
19.
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1 to 3 days
3 to 7 days
7 to 10 days
10 to 14 days
2 to 8 weeks
>2 months
Page 116
Sr. No.
P.M. No.
1.
886/13
>2.000
>2.000
>2.000
8 hours
2.
887/13
>2.000
>2.000
>2.000
10 hours
3.
987/13
>2.000
>2.000
>2.000
19 hours
4.
1014/13
>2.000
>2.000
>2.000
16 hours
5.
1129/13
>2.000
>2.000
>2.000
16 hours
6.
1423/13
>2.000
>2.000
>2.000
12 hours
7.
1426/13
>2.000
>2.000
>2.000
17 hours
8.
1436/13
>2.000
>2.000
>2.000
5 hours
9.
2170/13
>2.000
>2.000
>2.000
12 hours
10.
2239/13
0.063
0.051
0.093
6 hours
11.
2303/13
>2.000
>2.000
>2.000
18 hours
12.
2308/13
>2.000
>2.000
>2.000
24 hours
Inference
Markedly
increased
Markedly
increased
Markedly
increased
Markedly
increased
Markedly
increased
Markedly
increased
Markedly
increased
Markedly
increased
Markedly
increased
Normal
Markedly
increased
Markedly
increased
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P.M. No.
1.
890/13
>2.000
>2.000
>2.000
30 hours
2.
894/13
>2.000
>2.000
>2.000
28 hours
3.
982/13
>2.000
>2.000
>2.000
40 hours
4.
5.
1010/13
1121/13
0.05
0.05
0.06
0.08
0.03
0.06
6 hours
8 hours
6.
1420/13
>2.000
>2.000
>2.000
36 hours
Inference
Markedly
increased
Markedly
increased
Markedly
increased
Normal
Normal
Markedly
increased
Observations
Evidence of early myocardial infarction
Evidence of early myocardial infarction and old infarction
No. of cases
4
3
Observations
Evidence of early myocardial infarction
Evidence of old infarction
Normal myocardial histology. No areas of infarction
No. of cases
Nil
2
4
Marker
Aspartate amino Transferase (AST, SGOT)
Creatine Kinase isoenzyme (CK-MB
(CK
activity)
Lactate
ctate dehydrogenase isoenzymes (ratio of LDH1 to LDH2)
Creatine
eatine Kinase-MB
Kinase
mass concentration
Troponin I, Troponin T
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